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Getting Ready: Medical School Years 1-3

Written by Karen Hamilton, PhD, Assistant Dean, Multicultural Affairs, University of Pennsylvania School of Medicine

Creating Your Support Group
Whether you matriculate at a majority medical school or a predominately minority medical school, you will find the learning environment to be different from college, and the pace for learning the subject matter much faster. Remember that what makes medical school difficult is the amount of material you have to learn, and nobody can learn it all.  With this in mind, you’ll have to keep reminding yourself that to become a good doctor, you must understand and know the subject matter. Try, however, to schedule time off in your daily schedule.  If you don't, you'll "get burned out".

In order to reach your goal of becoming a doctor, you’ll need to have a support group.   Don’t isolate yourself.   Even the most capable students need a strong support system. The people in your support group will be able to furnish and clarify options for choosing a medical specialty.  The types of people comprising your group can include: a faculty member or physician who can serve as a mentor, a friend with whom you can vent when things get stressful, someone with whom you can study, or someone with whom you can relax. If you attend a majority medical school, perhaps, you might find the beginnings of a support system within the Office of Minority/ Multicultural Affairs.  The administrators themselves could be part of your support group. Additionally, by visiting this office from time to time, you’ll probably meet and make friends with other minority students.  You might also find in the Office of Minority/Multicultural Affairs, upper-class students who could serve as peer academic counselors. Some medical schools have a Mentoring Program for its minority students sponsored by the Office of Minority/Multicultural Affairs in which upper-class minority students provide academic advice to first year students.  In addition, these upperclassmen sometimes give or lend books and old exams.  The Office of Minority/Multicultural Affairs staff might also provide you with the names of faculty or practicing physicians in the community who could be your potential mentors and could give you advice about choosing a specialty and residency program.  If you attend a predominately minority medical school, you might get this same type of help in the Office of Student Affairs.

Another way to meet people who could potentially provide support is to join one of your school's minority student organizations like the SNMA, BLHO, or the American Indian Medical Student Organization.   Such extracurricular activities are good ways to make new acquaintances, friends and study partners. 

You might also be able to make new friends by participating in a medically related co-curricular project. You will meet physicians who could influence you or give you important insights about medical specialties.   You can include this project on your C.V. and also request a letter of recommendation from the primary investigator that you could use for your residency applications.

Consider engaging in a research project or community health service activity during the summer between your first and second year. At the University of Pennsylvania Medical School we have a community health service program called “Bridging The Gaps" that enables first year medical students to partake in a variety of projects such as teaching nutrition at a day camp, providing health services to the elderly at a nursing home, or working in a clinic for the homeless.   These types of experiences during the summer or during the academic year indicate to residency program selection committees the initiative they are looking for in applicants.

If you think that you may be interested in a particular field, the summer between first and second year is also an opportunity to get involved in research or work closely with a faculty member within that specific area.

Also, remember to network.   Many students become involved in extra-curricular activities during years 1 and 2.  This can provide a positive diversion from the rigorous course load, and also, an opportunity to meet others in the medical field. Many student organizations such as the AMA, AMSA, and the SNMA have regional and national conferences, which allow you to meet students, residents, fellows, and faculty from all over the country.  Conference attendees may also include representatives from residency programs in which you are interested.  This provides you a golden opportunity to introduce yourself, learn more about the program and student opportunities for visiting electives or projects, and make a valuable contact at that institution.

Exploring A Medical Specialty
All specialties are available to you when you start medical school, but choosing one is a difficult decision. As early as the first year, you should do a personal assessment of yourself in terms of your likes, dislikes, skills and interests.   Other features like life style, family responsibilities and your value system should be included in your self-assessment.  These factors help define who you are and what kind of specialty best suits your goals. 

To that end, you may want to visit the Association of American Medical Colleges website and go to the Careers in Medicine section. This is a self-managed program “designed to assist you in understanding your options for choosing a specialty and applying to a residency program to meet your career objectives”. It offers several self-assessment tools. One helps you pinpoint your desired work environment. Another helps you determine job satisfaction criteria for your future career. Of particular importance are the Careers in Medicine Program “Specialty Profile Pages” that describe specialties and links to their societies and organizations. 

The Basic Science Years
Unlike college, you can't pick your courses or the time they meet.  Everybody takes the same basic science courses.   Most medical schools have two years of basic science courses, but there are some exceptions. The University of Pennsylvania Medical School curriculum, for example, covers the basic science subjects in one and one half years. At Duke Medical School they do it in one year.  However, regardless of the time span, here are a few recommendations that might help you succeed:

Get to know a variety of people in your class, and if you attend a majority medical school, get to know non-minority students as well with whom you can study and discuss the course material.

Facilitate your learning by asking questions and getting advice on how to approach the subject matter. Make sure you understand the material and ask questions of your instructors.  If you're too shy to ask in class, make sure you go to the review sessions or arrange to meet with your instructors outside of class.   Prior to meeting with them, however, organize yourself and outline what topics and questions you want to cover.

Join study groups.   They are often very useful if you use them to relearn or reinforce material.  If you find the members of the group waste time gossiping or fooling around join another one.

The USMLE, Step 1
If you don’t do particularly well on standardized exams, you’ll have to study particularly hard for this one.   For starters, take some time between the first and second year, to review your first year class notes. You’ll find that such a review will help reinforce what you've learned and help you prepare for the USMLE, Step1. Not only will you be better prepared for your second year, you will also have started the review process prior to most of your classmates.

Step 1 of the USMLE is especially important, because your score could influence your chances of obtaining a residency spot in one of the competitive residencies like orthopaedics, ophthalmology, dermatology and neurology. Even if you don't intend on matching in one of these residencies, the higher the score you receive the easier it will be for you to get an interview request at a particular program.

The best preparation for doing well on USMLE, Step 1 is learning the basic science material well during your first two years. This will allow you to spend preparatory weeks prior to the exam reviewing material you’ve already learned, instead of learning new material.   The exam is cumulative and comprehensive, so it would be difficult to memorize 2 years worth of  knowledge in 4-6 weeks. Also, it is very important to do as many practice questions as possible prior to taking Step 1.

As you study for the exam, have a positive attitude, and tell yourself that relearning the subject matter is a good way to reinforce what you ’ve learned so far.   As you study set time aside to take practice questions.  A week before the test, schedule a timed practice test to get accustomed to the time constraints of the test.  If your medical school offers one, you might consider taking a review course. These same tips are also applicable for USMLE, Step 2.

The Clinical Clerkships
The required clerkships include medicine, pediatrics, OB-GYN, surgery, and psychiatry. For a number of reasons, these courses are crucial to your success as a future physician. These clerkships give you your first real exposure to taking care of patients and working with other health care professionals.    They also give you a sense of what being a doctor is really all about.  Use this time to begin to evaluate potential specialty choices. As you take these courses, you should take notes comparing your own interests and skills versus the required skills of that particular specialty. If you enjoyed a particular clerkship, consider approaching the course director, attending or resident and ask them to help you identify a faculty member who could serve as an advisor. You will also likely want to do a sub-internship in this field.

Performing well in the required and elective clinical clerkships is dependent upon one learning the "rules of the game". Learning the "rules of the game" before you take the rotation is absolutely essential for each specialty.   Many medical schools have Case Presentation Seminar Series in which minority students learn the “do’s and don’ts” from a minority attending, resident or upper-class student who has already taken that particular specialty.  If your school does not have this type of program, perhaps your Office of Student Affairs or Minority/Multicultural Affairs can recommend a successful upper-class student who would be willing to share this same type of valuable information with you.

The grades and evaluations you receive in your clerkships will appear on your academic transcript and will comprise a major portion of your Dean’s Letter. The Dean’s Letter, as many of you know, is used as an evaluative summary of your medical school performance and is sent to the residency programs to which you apply. Refer to the sample Dean’s Letter in this booklet.  Because your clinical clerkships are evaluations are so critical as well as subjective, make sure you find out how well you are doing by asking for feedback early.  Many students don't ask for feedback, and later they are dissatisfied with their final evaluation. Therefore, as you progress through the rotation, ask such questions as: “What do I need to do in order to improve my case presentations?”   “ What do you think of my patient write-ups?” Try not to take things personally or think that there is a racial or ethnic bias against you if things don't go as well as you expect.  Instead, if you think you are having a problem during the rotation, discuss it first with a mentor, the Office of Multicultural/ Minority Affairs or Student Affairs staff or with an upper-class student whom you trust.

Choosing A Medical Specialty and Residency Program
After you've taken your required clerkships, you'll then have opportunities to take electives in some of the specialties in which you might be interested. These electives also offer opportunities to find mentors among the faculty and house staff. As mentioned earlier, the Association of American Medical Colleges Careers in Medicine Program has a very useful tool for learning about medical specialty options.  Discuss what you’ve read with your mentor(s) and ask their opinions.  In conjunction with the Careers in Medicine Program, you can review your school's match rate success, and talk to your Dean of Students and Program Director to learn his/her assessment of your chances to match in the specialty and residency program that you are considering.

For those of you who might be interested in academic medicine as a career, you should aim to match in a strong residency program.   The same tendency holds true if you're interested in doing a sub-specialty, because fellowship program directors look favorably upon candidates who come from good residency programs.

As a minority student you may have special concerns about selecting a residency program.   It is expected to have apprehensions about the possibility of being the only minority or one among few in a residency program or teaching hospital. Limited social opportunities to mingle with fellow minority residents could determine or influence your residency program decision.  Since residents often begin career networking while doing their training, you need to consider whether the city and residency program you are considering will provide meaningful career contacts.

To get “a feel for the place”, some students consider doing an "away" elective at the training program to which they are considering applying to.  These electives are often referred to as "audition" electives.  In considering whether you should take this route, you must decide if you are willing to take the chance of being a big hit or not.   Understandably, doing poorly will decrease your chances for matching, but doing well might give you a decided edge.

Good luck, and I wish you much success in obtaining your first choice!